Provider Demographics
NPI:1033139845
Name:LYSGAARD, KENT A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:A
Last Name:LYSGAARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 CASCADE VALLEY CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0481
Mailing Address - Country:US
Mailing Address - Phone:702-360-9061
Mailing Address - Fax:
Practice Address - Street 1:7180 CASCADE VALLEY CT
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0481
Practice Address - Country:US
Practice Address - Phone:702-360-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist